New Updates in Uses Of Extra Corporeal Membrane Oxygenation

Abstract

Extracorporeal membrane oxygenation (ECMO) is a form of partial pulmonary and/or cardiopulmonary bypass used for short term (days to weeks) support of patients in severe pulmonary and/or cardiac failure. ECMO is a form of mechanical assist therapy that employs an extracorporeal blood circuit including an oxygenator and a pump. There are two main types of ECMO: veno-arterial (VA) and veno- venous (VV). VA ECMO provides both cardiac and respiratory support, whereas VV ECMO only provides respiratory support. In adults, VA ECMO is used primarily for refractory cardiogenic shock. In contrast, VV ECMO is favored in patients with isolated severe respiratory failure in the absence of major cardiac dysfunction. More efficient membrane oxygenators and novel cannulation strategies have broadened the indications for which ECMO may offer a benefit, including hypercapnic respiratory failure, cardiogenic shock and cardiac arrest. Ultimately, more studies are needed to determine the appropriate use and clinical impact of ECMO on respiratory and cardiac failure. Once ECMO support has been started, the goal is to preserve all organs and recover those injured. A daily metabolic panel verifies proper perfusion and oxygenation. Arterial gases and coagulation panel readings must be obtained hourly; especially during the first hours of support. ECMO flows should be adjusted according to the patient needs. On one hand, flows should be sufficient to k